Syphilitic Optic Neuropathy: Diagnosis Not To Be Missed

Purpose of the study: To describe two cases of syphilis presenting with optic neuropathy and to highlight the importance of considering syphilis in the evaluation of optic neuropathy. Method: Complete physical and ophthalmologic examination was performed in patients along with the necessary laboratory investigations including cerebrospinal fluid (CSF) analysis, syphilis serology in serum and CSF and HIV serology. Results: Both patients presented with unilateral optic perineuritis evident as swollen optic discs, normal visual acuity and normal pupillary reactions to light and accommodation. Complete recovery of optic neuropathy was achieved in both patients following treatment with procaine penicillin which was administered with oral probenecid and a short course of steroids. Conclusion: Early diagnosis and prompt treatment with penicillin is essential to prevent visual impairment in syphilitic optic neuropathy.